Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 73. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 714 Section Spinal Deformities and Malformations Case Introduction Female patient with a 22-year history of low back pain and a de novo scoliosis primary degenerative scoliosis exemplifying the natural history of this scoliosis type. The patient first sought medical help for low back pain at the age of 33 years. The radiograph exhibited a short left-convex lumbar scoliosis 8 which in retrospect can be attributed to a disc degeneration of L3 4 disc space narrowing and an asymmetry at the L2 3 level a . At that time the patient was treated with NSAIDsand physiotherapy with some improvement. However she was never really pain-free. When she was 50 years old she had increasing back pain with radiating pain mostly into the right anterior thigh. In the meantime the patient entered menopause and the curve now measured a Cobb angle of 25 with a lateral translation and rotation of L3 toward the left side b . Five years later the curve measured 40 an average 3 curve increase per year. The curve was now clearly identifiable as a short left-convex curve from L2-L4 end vertebrae c .The overall frontal balance was still more or less in equilibrium. However the sagittal profile converted toward a lumbar kyphosis. The patient now complained not only about difficulty of controlling back pain but also about classical claudication symptoms when walking 400-500 pain disappeared when resting. The back pain was much less when resting in bed but increased when standing up in the vertical position. The translation rotation of the apical vertebra L3 had also increased compared to 5 years previously. This curve demonstrates a truly progressive degenerative de novo adult scoliosis which ended with the complete set of symptomsand signs which finally necessitate surgery. This process involves a mechanical deterioration of the lumbar spine which expresses itself in clinical signs and symptoms related to instability mostly axial-vertical instability with some translational component central
